Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies.

OBJECTIVES: Proton pump inhibitors (PPIs) are widely used in several acid-related gastrointestinal disorders. In vivo studies have suggested that gastric suppression by PPIs could result in decreased intestinal calcium absorption. Subsequently, there have been concerns that the chronic use of a PPI is associated with an increased risk of bone fracture. However, the results of clinical studies are conflicting. METHODS: We performed a systematic review and meta-analysis of controlled observational studies to evaluate the risks of PPI use on fracture outcome. All controlled observational studies that compared fracture outcome in patients with PPI therapy with a control group were included. We calculated pooled odds ratios (ORs) using a random-effects model. RESULTS: Of 1,668 identified studies, 10 (4 cohort and 6 case-control) with 223,210 fracture cases were included in our analysis. In PPI users, compared with non/past users, the OR for hip fracture (n=9) was 1.25 (95% confidence interval (CI)=1.14-1.37). The OR for vertebral fracture (n=4) was 1.50 (95% CI=1.32-1.72) and for wrist/forearm fracture (n=3) was 1.09 (95% CI=0.95-1.24). In subgroup analysis of hip fracture, this association was observed in both high-dose and low-dose PPI exposure. When stratified by duration of exposure, the short duration of PPI use was associated with increased risk of developing hip fracture (OR=1.24; 95% CI=1.19-1.28), whereas there was no significant increase in risk of hip fracture in long-term PPI users (OR=1.30; 95% CI=0.98-1.70). There was significant statistical and clinical heterogeneity among studies for the main analysis and most of the subgroup analyses. CONCLUSIONS: Our results should be interpreted with caution. We found a modest association between PPI use and increased risk of hip and vertebral fractures, but no evidence of duration effect in subgroup analysis. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or a result of unmeasured/residual confounding. Thus, randomized controlled studies are required to confirm or refute these results.

Can jua be a weapon in combating oral diseases?

Jua (or Joazeiro) is a plant that has been used in Brazil as a folk remedy for many diseases, but mostly as a dentifrice. Several scientific investigations have been conducted in Brazil to examine the therapeutic use of Jua for oral health. This article presents information about the Ziziphus joazeiro plant, its medicinal use, and its chemical components while also reviewing the literature concerning Jua and especially its anti-plaque activity. Although Joazeiro has been investigated, more studies must be performed to better understand these Jua compounds, their antimicrobial activity, and their mechanism of action. Such studies would confirm whether Joazeiro has the potential to fight or prevent diseases like dental caries and periodontitis.

Physical properties of denture base resins potentially resistant to Candida adhesion.

PURPOSE: The addition of anionic charge on denture base resins has been shown to inhibit Candida albicans adhesion and to facilitate adsorption of salivary defense molecules. The aim of this study was to evaluate the physical properties of a modified denture base resin for denture fabrication. MATERIALS AND METHODS: Specimens made from heat polymerizing resin Lucitone 199 were used as the control group. The two experimental groups, E-10 and E-20, had 10% and 20%, respectively, of the monomer substituted with an experimental phosphate-containing monomer. Flexural strength and modulus, water sorption, solubility, and color stability tests were conducted to ensure compliance with ADA specification No. 12. Water diffusion coefficient into the resins and stainability were also assessed. ANOVA and Scheffé tests were performed for statistical significance. RESULTS: There was an overall decline in all properties with the addition of the experimental phosphate compound. The flexural strength and modulus, water sorption and solubility for E-10, as well as the control were, however, within the ADA specifications. The diffusion coefficients were significantly different (p < 0.05) for the three groups. Staining and color specimens showed no significant difference (p > 0.05) among the three groups. CONCLUSIONS: Within the limitations of this study, the physical properties of the phosphate denture base resin at 10% should be suitable for denture fabrication based on the properties assessed.

The effect of EDTA in attachment gain and root coverage.

Root surface biomodification using low pH agents such as citric acid and tetracycline has been proposed to enhance root coverage following connective tissue grafting. The authors hypothesized that root conditioning with neutral pH edetic acid would improve vertical recession depth, root surface coverage, pocket depth, and clinical attachment levels. Twenty teeth in 10 patients with Miller class I and II recession were treated with connective tissue grafting. The experimental sites received 24% edetic acid in sterile distilled water applied to the root surface for 2 minutes before grafting. Controls were pretreated with only sterile distilled water. Measurements were evaluated before surgery and 6 months after surgery. Analysis of variance was used to determine differences between experimental and control groups. We found significant postoperative improvements in vertical recession depth, root surface coverage, and clinical attachment levels in test and control groups, compared to postoperative data. Pocket depth differences were not significant (P<.01).

Effective pain management in the long-term care setting.

It is essential that physicians and midlevel practitioners who care for residents in long-term care facilities be proficient in the recognition, assessment, and treatment of chronic pain. A holistic approach to the physical, emotional, social, and spiritual components of a resident's total pain and distress must be integrated into the palliative aspects of long-term care medicine. Furthermore, all practitioners must recognize and effectively manage, prevent, and/or minimize the occurrence of acute pain, breakthrough pain, incidental pain, and disturbance pain that frequently are superimposed on a resident's chronic pain.